Why Contagion Didn't Get an Oscar Nod

With the Academy Awards approaching, I'm wrapping up my yearly quest to see as many of the movies nominated for Best Picture as possible before the show. Working my way through the list of nominated movies, I enjoyed the clever film The Artist, even though I was initially loathe to watch a French silent film about actors set during the Depression.

But this year's Oscar nominations have been frustrating for me as well, because I thought that Contagion would be nominated for Best Picture or for another major Academy award. Hollywood politics no doubt played a part in the nominations. But I wonder whether the Academy's passover of Contagion comes from a more primal place.

Contagion, which I saw in the fall, was a very difficult movie to watch. Although the script sometimes veered into science lecture territory, in general the movie seemed realistic and frightening as it documented how quickly a lethal virus could spread worldwide.

For me, the movie brought up fresh memories of the 2009 swine flu (H1N1) pandemic. I had been concerned about swine flu, not panicked about it, and mostly allayed my fears by passing out bottles of hand sanitizer to family members.

Because my pediatrician did not have access to the new H1N1 vaccine, in the fall of 2009 I took the kids to a local clinic to get vaccinated, waiting in line with other families and seniors. As the line grew and wrapped around the block, a rumor spread that the clinic had run out of the vaccine.

Suddenly, the police showed up, as if they expected the parents and seniors to riot in the street (and do what? Toss sippy cups and canes at them?). Their presence did not calm people down. It just made all of us nervous: what was going on? As it turned out, the clinic did have enough vaccine, and after waiting several hours in line, the kids got their shots. But the edginess in the line, and in the city, was real.

Now, many of us don't think much about the possibility of another influenza pandemic, until a movie like Contagion is released. Or until researchers are asked to suspend their work on developing a flu strain that is considered a biosecurity threat, as happened earlier this year.

Everyone's a little jumpy these days. Maybe even Hollywood, whose idea of entertainment includes a mother in a coma (The Descendants) and an actor in a downward spiral (The Artist), finds a movie about a global pandemic a bit too disturbing.

Flu Vaccine Season Returns, With a Twist

With the H1N1 "swine flu" pandemic officially over - as of last week - WebMD reports that the CDC is gearing up for a seasonal flu vaccination campaign in September called "Flu Ends with U." Maybe the campaign will help clear up a heap of confusion about flu vaccines these days.

Part of the problem is that flu vaccination recommendations have changed substantially over the past few years. In 2010-2011, for the first time ever, the flu vaccine is recommended for everyone 6 months or older (anyone can have the flu shot, containing killed flu viruses; the flu nasal spray contains inactivated (modified) live flu viruses and is recommended for a smaller subset of people).

In 2009, the CDC recommended the seasonal flu vaccine only for children ages 6 months to 18 years, and adults ages 50 and over (with some exceptions for certain younger adults). In 2008, the flu vaccine was only recommended for children ages 6 months to 5 years old and adults 50 and over (with some exceptions).

The viruses that cause the flu are constantly mutating, and in response a new flu vaccine has to be developed each year, at least until researchers figure out how to make a universal flu vaccine that can provide long-term protection. Researchers make an educated guess about which three flu viruses will cause the most damage in the future, then modify the viruses to use them in vaccines by growing them, usually in chicken eggs, a time-consuming process. If a different flu virus spreads, the vaccine won't protect against it.

The WebMD article pointed out CDC focus group research that found that many people are not happy with the universal flu vaccination recommendations. Catching the flu is not a big deal to many people, but it can have serious consequences for some. On average, about 36,000 people die from flu complications each year, primarily the elderly. In 2009, about 12,000 Americans died from complications of swine flu, mostly those under age 65, according to the CDC.

The flu vaccinations recommendations have changed over the years to protect a wider range of people, and also to keep healthier people from catching and passing on the flu to others. It might be inconvenient to get flu vaccinations for the whole family, but it's still a good idea.

 
Resources:

• The CDC's 2010-2011 Vaccine Information Sheets contain information about both the flu shot and the flu nasal spray.
• Prevent the spread of disease by washing your hands when needed. The Mayo Clinic tells you when and how to wash your hands.

Is the H1N1 Vaccine Safe?

Is the H1N1 vaccine safe? I've heard this question a lot since I began promoting the book I co-authored, The Complete Idiot's Guide to Vaccinations. Young adults and mothers of young children tend to ask me about the H1N1 vaccine, because they are weighing the risks and benefits of getting vaccinated.

Modern vaccines are extremely safe. Problems such as bacterial contamination of vaccines, a serious threat several generations ago, has been largely eliminated through the use of preservatives and improved packaging. Many older vaccines have also been reformulated to reduce the risk of side effects (such as the old DTP vaccine, and the earlier rotavirus vaccine for children).

The H1N1 vaccine is made in the same way as the seasonal flu vaccine. The viruses that cause the flu are grown and biologically weakened in chicken cells, until they are still strong enough to create an immune system response in people, but too weak to cause the disease in a healthy person. Then the weakened viruses are either:

• killed and used in the seasonal or H1N1 flu shot (the best choice for people with weakened immune systems or other risks), or 
• kept alive and used in the seasonal or H1N1 flu nasal spray vaccine (the best choice for certain people with healthy immune systems).

The seasonal flu shot has been available since the middle of the last century; the nasal spray flu vaccine was licensed in the United States in 2003.

The CDC tracks health problems that might be linked to vaccines with the Vaccine Adverse Event Reporting System (VAERS). Both health care providers and the general public can report health problems that occurred after a vaccination to VAERS. Researchers monitor VAERS, looking for patterns of problems with a vaccine. If a pattern does occur, then they do further research within the Vaccine Safety Datalink (VSD), a database containing the health records from eight managed-care organizations across the country.

What have they found since they have been tracking the H1N1 flu vaccine? The CDC's Dec 11 Morbidity and Mortality Weekly Report (MMWR) found that the risk of serious side effects (adverse events) from the H1N1 vaccine is about the same as the risk for the seasonal vaccine. In a word: low. From October through November 2009, VAERS data showed 82 adverse events per million doses of H1N1, and 47 adverse events per million doses of seasonal flu vaccine.

Still, the rumors are flying about the H1N1 vaccine: that it can cause Gulf War Syndrome or Guillain-Barre syndrome, that it contains Agent Orange, and so on. The website FactCheck.org's "Inoculation Misinformation" article provides a good overview and rebuttal of some of the questions that have cropped up in emails and online about the H1N1 vaccine.

Understanding Swine Flu

Is swine flu the next influenza pandemic? Swine flu does share genetic material with the flu strain that caused the influenza outbreak of 1918-1919, a strain that has been circulating on and off since then. Older adults are more likely to have encountered a version of this flu strain when they were younger, giving them better protection against it now. This topic is familiar to me because I was researching swine flu earlier this year as part of a book about vaccinations that I'm working on with a pediatric epidemiologist.

The 1918-1919 pandemic, the most famous influenza pandemic, infected about 30% of Americans. About 2% of the cases were fatal in an age without antiviral drugs and other medical interventions. Even then-president Woodrow Wilson caught the flu during the pandemic (and survived). Ultimately, influenza killed about 675,000 Americans between 1918 and 1919, an unlikely scenario in the U.S. today with improved medical care and a much better understanding of how infectious diseases spread.

The 1918-1919 flu pandemic was different from the seasonal flu because it spread extremely rapidly, and young adults, rather than the elderly, were most likely to die from the virus. The first U.S. cases in the pandemic were reported among soldiers on a military base in Kansas in 1918, arguably the healthiest members of society, although living in close quarters makes them more susceptible to infectious diseases.

The swine flu that began this month in Mexico is also most deadly among young adults, with numerous sad stories circulating about flu-related deaths in young adults in Mexico and the death of a child in the United States. Swine flu, an illness that pigs get, is sometimes transmitted from pigs to humans (i.e. only those who have been physically near pigs catch the virus). Rarely, swine flu has been transmitted from humans to humans. It has cropped up a few times in the past, most notably in 1976, when about 200 soldiers in Fort Dix, New Jersey were infected, four developed pneumonia, and one died. At Fort Dix, there was no evidence that the soldiers had had contact with pigs. The virus had mutated and was now transmitted from person to person.

Periodically, influenza viruses mutate into something new and more serious, with a potential to spread worldwide (causing a pandemic). For this reason, the 1976 swine flu cases spurred a strong response. A vaccine was developed and a mass swine flu vaccination campaign began that year. About 45 million people were vaccinated against the disease in 1976. The swine flu vaccine used then, however, was later recalled because it appeared to slightly increase the risk of developing a rare neurological problem called Guillain-Barre Syndrome (GBS) which can cause temporary paralysis. Swine flu did not spread and become a pandemic as feared.

For a long time, epidemiologists have been concerned about the source of the next influenza pandemic, often targeting avian influenza ("bird flu"). The swine flu virus circulating today, a mixture of pig, bird, and human viruses, is not a pandemic but it has the potential to become a problem. If you take precautions such as washing your hands adequately and often, however, you can help protect yourself and others.

The seasonal flu (influenza) itself causes plenty of problems every year. The CDC recommends a yearly flu vaccination for children up to age 18 (in part because they often pass on flu to the adults around them), adults 50 and over, and certain other groups of people such as health care providers. (This season's flu vaccination does not protect against swine flu.) Although most people recover easily from the seasonal flu, very young children and the elderly are far more likely to suffer from complications such as pneumonia if they catch it. Many people do not get their recommended flu shot each year. As a result, seasonal influenza is the top cause of vaccine-preventable deaths in United States, killing 36,000 and hospitalizing 226,000 each year, according to the CDC.

You can learn more about swine flu and how to avoid it at the CDC's Swine Influenza and You web page.

You can get updates on what's happening with the swine flu at the CDC Emergency Twitter site.

Google Flu Data Rivals CDC

Last week, internet search giant Google released the Google Flu Trends tool, which tracks possible flu outbreaks by compiling data on how often people use flu-related search terms such as "flu symptoms" and "chest congestion". Google Flu Trends provides raw data, but not context. Each year, close to 100 million Americans search for health information online, but not everyone who searches for health information is injured or ill. Since I write about medicine, for example, I usually search for health information online for my writing projects, not personal knowledge. Other searches, it seems, might be done out of idle curiosity, or even result from a keystroke error in the search bar.

Is Google Flu Trends just another odd little Google project that their employees tinker with at the Googleplex in Mountain View in between running the search engine and scanning in every book ever written? Apparently not. Google mapped five years' worth of their flu data against flu data from the Centers for Disease Control and Prevention (CDC), which the agency compiles from health care providers, emergency room visit statistics, and other sources. Data from Google correlated closely with CDC data, often predicting flu outbreaks a week or two before the CDC. Google will soon publish a paper on its methodology in an upcoming issue of Nature.

Health care researchers already search for trends in anonymized electronic medical records (EMRs) that some practices use to record patient medical data and prescriptions. More digital data will become available in the future as EMRs become more common (especially since the federal government is providing financial incentives for Medicare providers to adopt e-prescribing, starting in 2009) .

For various reasons, however, many patients are not entirely honest with their doctors about their symptoms and medical concerns, a problem health care providers have struggled with for years. A patient might be embarrassed about a medical problem, forget to mention a symptom, or simply not realize that a symptom is significant. For this reason, search engine data might provide an even larger, and potentially more accurate, data pool than EMRs to indicate the actual incidence of conditions such as pre-diabetes or early heart disease, for example. Public health officials could then use the data to create more effective screening and prevention campaigns.